Clinical and economic burden of obstructive hypertrophic cardiomyopathy in the United States

Abstract

Aims: Obstructive hypertrophic cardiomyopathy (oHCM) is a disease of the cardiomyocyte in which dynamic left ventricular outflow track obstruction may lead to heart failure, valvular disease, and sudden death. Little is known about healthcare resource utilization (HRU) and costs associated with oHCM. This study investigated the clinical and economic burden of oHCM in patients with or without symptoms associated with oHCM. Methods:We used the US IBM® MarketScan® Commercial and Medicare Supplemental database to identify patients with oHCM (January 2009-March 2019). Control patients without cardiomyopathy were matched to each patient with oHCM based on age, sex, region, and index year (3:1 ratio). One-year HRU and cost data were compared between all oHCM, symptomatic oHCM, and asymptomatic oHCM subgroups, and their respective controls.Results: Among 11,401 eligible patients with oHCM (mean age 57 years, 42% female), 5,667 (50%) were symptomatic (23% chest pain, 57% dyspnea, 29% fatigue, 17% syncope). oHCM was associated with significant increases in all-cause hospitalizations, hospital days, outpatient visits, and total healthcare costs (mean ± standard deviation: $26,929±77,720 vs. $6,808±25,712, p<.001) compared with matched controls. These differences were driven mainly by the clinical and economic burden of symptomatic oHCM, which was associated with significant increases in 1-year hospitalization rates (38.0% vs. 6.9%), hospital days (3.7±9.9 vs. 0.4±3.0), and total healthcare costs ($43,586±103,756 vs. $6,768±27,618; all p<.001). Adjustment for comorbidities had minimal impact on these differences. Limitations:The use of claims data relies on International Classification of Diseases (ICD-9 and ICD-10) diagnosis codes, which might be inaccurate. Only commercially insured patients were included. Conclusion:In a real-world population, oHCM was associated with substantial increases in HRU and incremental

Clinical Characteristics and Healthcare Resource Utilization among Patients with Obstructive Hypertrophic Cardiomyopathy Treated in a Range of Settings in the United States

“…Contrary to previous investigations, comorbidities in this cohort were remarkably higher than previously reported at HCM centers [2,4,6,7,9]. However, rates of comorbidities, drug therapy, and HCM-related outcomes were similar in comparison to recent investigations using IBM MarketScan Commercial and Medicare claims data [24,25]; however, our study utilized IBM EMR data. Regardless, these studies [24,25], like our results, highlight the differences in real-world HCRU and outcomes among patients with oHCM compared with HCM centers.…”

“…However, rates of comorbidities, drug therapy, and HCM-related outcomes were similar in comparison to recent investigations using IBM MarketScan Commercial and Medicare claims data [24,25]; however, our study utilized IBM EMR data. Regardless, these studies [24,25], like our results, highlight the differences in real-world HCRU and outcomes among patients with oHCM compared with HCM centers. This may reflect differences in disease management between community-based practice and specialized HCM centers of excellence; however, the high rates of comorbidities may also be partly due to a lack of specific and appropriate use of ICD codes.…”

Quality of life and societal costs in hypertrophic cardiomyopathy: protocol of the AFFECT-HCM study

“…This might be subjective and may sometimes be based on estimations. However, previous cost-of-illness studies used aggregated databases and thus neglected important information about broader costs such as patient and family costs, productivity losses and costs beyond healthcare, which are included in this study [10][11][12]. Secondly, the to-be-used questionnaires are validated for an adult population only, hence minors will be excluded [20].…”

“…1 The structured timeline of the study per subject. QoL quality of life, EQ-5D-5L EuroQol questionnaire, KCCQ Kansas City cardiomyopathy questionnaire, iMCQ medical consumption questionnaire, iPCQ productivity cost questionnaire about broader cost types [10][11][12]. Furthermore, QoL studies are rare and none have measured QoL with the EQ-5D-5L, the required instrument according to Dutch guidelines [5,[13][14][15].…”

Longitudinal Psychometric Analysis of the Hypertrophic Cardiomyopathy Symptom Questionnaire (HCMSQ) Using Outcomes from the Phase III EXPLORER-HCM Trial

“…HCM is classified as obstructive or nonobstructive based on the presence or absence of left ventricular outflow tract (LVOT) obstruction [3,5,6]. Approximately two-thirds of patients with HCM are affected by obstructive HCM [6], and it is estimated that 50% of all patients diagnosed with obstructive HCM have one or more symptoms related to the condition [7].…”